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 Women who had surgical deliveries known as C-sections were also more
likely to be overweight, or to develop complications like diabetes
and high blood pressure during pregnancy, than women who had vaginal
births, the study found.
After these maternal factors were taken into account, delivery by
C-section was still linked to a 15 percent increase in the risk of
obesity by the time babies reached adolescence and early adulthood.
“I was expecting that after controlling for these factors the
association between cesarean birth and childhood obesity would
completely disappear,” said senior study author Dr. Jorge Chavarro,
a public health and nutrition researcher at Brigham and Women’s
Hospital and Harvard Medical School in Boston.
“That was not the case,” Chavarro added by email.
Even within families, children born by C-section were 64 percent
more likely to be obese than their siblings born by vaginal
delivery, researchers report in JAMA Pediatrics.
Children born by vaginal birth to women with a previous cesarean
delivery were 31 percent less likely to be obese than kids born to
women with repeated cesarean deliveries, the study also found.
While cesarean deliveries are often necessary to save lives and
prevent injuries, they may also leave babies vulnerable to chronic
health problems such as asthma, diabetes and obesity, some previous
research suggests.
To explore the connection between C-section deliveries and obesity
in particular, Chavarro and colleagues examined data on 22,068
children born to 15,271 women, including 4,921 born by cesarean
delivery.
From 1996, when the kids were between 9 and 14 years old, through
2012, when most participants were in their mid-to-late 20s, the
researchers tracked their weight and height.
One limitation of the study is that researchers lacked data on why
women had C-sections or other aspects of labor and delivery, the
authors note.
The study also didn’t show why C-sections might make obesity more
likely, though the authors say it’s possible babies delivered this
way may not be exposed to good bacteria in the birth canal that help
build the immune system and ward off obesity and other diseases.
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Still, the findings offer the strongest epidemiologic evidence to
date that C-sections may cause obesity, said Dr. Jan Blustein, a
health policy researcher at New York University who wasn’t involved
in the study.
“When cesarean is indicated, it can save lives,” Blustein said by
email. “But experts agree that too many cesareans are performed
without clear indication.”
Ideally, no more than 15 percent of deliveries should be C-sections,
according to the World Health Organization. That’s the approximate
proportion of births that require surgical intervention to protect
the mother or infant in situations such as prolonged labor, fetal
distress or a breech baby.
In the U.S. and many other developed nations, however, C-section
rates are more than double what WHO recommends.
While the study doesn’t show why C-sections may be associated with
obesity, women should still aim to maintain a healthy weight before
getting pregnant and keep weight gain to a healthy range during
pregnancy, said Dr. Amos Grunebaum, director of obstetrics at New
York-Presbyterian Hospital Weill Cornell Medical Center.
“Because of increased risks, mostly to the mother, cesareans should
be done only for proper indications,” Grunebaum, who wasn’t involved
in the study, said by email.
Still, these deliveries have their place, he emphasized.
“The speculative future risk of obesity in the offspring should
never be a good enough reason to not do a cesarean, especially when
it’s done to save the baby’s or mother’s life,” Grunebaum said.
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